Buprenorphine: “Field Trials” of a New Drug

Abstract

Buprenorphine is being introduced as a new treatment drug for narcotics addiction in the United States. The authors were asked by the National Institute on Drug Abuse to conduct a field trial to determine if buprenorphine might play a role in street markets. Because no street use of the drug existed in the United States, the authors used three sources of information: (a) “street readings” of clinical studies, (b) Internet discussion lists, and (c) research in other countries. By using an emergent style of analysis that relies on replication of patterns across disparate data sources, it was determined that buprenorphine has desirable characteristics from a street addict point of view. An evaluation of the field trial 5 years later evaluates its accuracy.

Illicit use of buprenorphine in a community sample of young adult non-medical users of pharmaceutical opioids

“…In their 2001 study, Agar and colleagues asked, “Does buprenorphine possibly have a future in the U.S. street markets?” They answered: “Possibly, without a doubt; probably, it depends” (Agar et al, 2001). Our study clearly indicates that non-medical use of buprenorphine has found a niche in the streets among illicit users of pharmaceutical opioids.…”

“…Numerous trials have established buprenorphine’s utility in the treatment of opioid dependence (Johnson et al, 1995; Johnson et al, 2000; Amass et al, 2004; Ling et al, 2005), and its use in substance abuse treatment has been rapidly increasing (DEA, 2011, February; Yokell et al, 2011). Although years of clinical research and post-marketing data show that buprenorphine misuse carries lower risk of serious side effects compared to other opioids (Bridge et al, 2003), cases of buprenorphine abuse and related morbidity and mortality (including adverse events linked to injection and unintentional overdoses) have been documented in many countries around the world (Chowdhury and Chowdhury, 1990; Tracqui et al, 1998a; Tracqui et al, 1998b; Agar et al, 2001; Vidal-Trecan et al, 2003; Jenkinson et al, 2005; Schifano et al, 2005; Parfitt, 2006; Bruce et al, 2008; Yokell et al, 2011). There is growing evidence that these products are being diverted in the U.S. (Cicero et al, 2007; Smith et al, 2007; Dasgupta et al, 2010; Maxwell and McCance-Katz, 2010; Johanson et al, 2011).…”

Uses of Diverted Methadone and Buprenorphine by Opioid‐Addicted Individuals in Baltimore, Maryland

“…(15,16) In recent years, the widespread availability of buprenorphine treatment through primary care physicians in France was found to be associated with a significant decrease in heroin-overdose deaths, crime, and HIV transmission, (17) yet its availability as a source of treatment has also led to some buprenorphine diversion and misuse by injection, and to some overdose deaths when injected with benzodiazepines. (17,18,19) Other recent reports indicate that buprenorphine from France and other western European countries is being diverted to Georgia, a country in which buprenorphine is not legally available, where it has contributed to rising levels of injection drug abuse. (20) Buprenorphine has also been identified as a drug of abuse for polydrug injectors in Finland, (21) Australia, (22) Singapore and Malaysia, (23) and India.…”

Suboxone Misuse Along the Opiate Maintenance Treatment Pathway

“…An effective maintenance drug will always be interesting to the streets as well." 25 Similarly, in a comprehensive review of the potential misuse of buprenorphine, the authors noted that "any mood altering drug can be abused; however, it should be emphasized that this is not to cast aspersions on the use of buprenorphine as a maintenance drug." 4 Another study raises the specter of the unintended consequences of buprenorphine as a drug treatment remedy, particularly its sale as a street drug and subsequent misuse.…”

“…In a prescient study on buprenorphine and its potential as a street drug, the authors noted the inherent contradiction between an opiate maintenance drug and its misuse. 25 They pointed out that "It is not a matter of reconciling a contradiction. It is a matter of accepting that you cannot have one without the other.…”